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Dane County For Office Use Only—Revised 03.21.2016 <br /> Erosion Control Permit Permit Number: <br /> Application Application Received By: Date: <br /> (Application must be made in person. Application Approved By: Date: <br /> Incomplete applications will not be accepted.) <br /> Associated Permits: <br /> Project Name:Montgomery Residence Applicant Information (Individual making in-person application) <br /> Landowner Name(s): Kieran & Isabel Montgomery Applicant Name: Kieran Montgomery <br /> Landowner Address: 2187 Colladay Point Dr Applicant Address: 1172 Maple Grove Road <br /> Stoughton, WI 53589 Stoughton, WI 53589 <br /> Landowner Phone: (608) 225-4421 Applicant Phone: (608) 225-4421 <br /> Landowner E-mail: kieran @ctwf loorinq . corn Applicant E-mail: kieran @ctwf loorinq. corn <br /> Name and company of engineer/consultant who prepared the plans: Rob Montgomery/Montgomery Assoc . <br /> Type of Permit: ❑ Erosion Control Shoreland Erosion Control <br /> (check only one) (EC) 1J (SE) <br /> Municipality:Town of Dunn Section: 23 Quarter:SE Parcel#: 0601-234-4680-5 <br /> Fee Calculation(all projects must include disturbed area and new impervious area) <br /> Total Disturbed Area 10 , 10 0 ft2x$0.005/ft2 =$ 50 . 50 <br /> Total New Impervious Area 3 , 380 ft2 <br /> (includes gravel) <br /> Total Redevelopment Impervious Area ft2 <br /> (includes gravel) <br /> Base Fee: Erosion Control(EC) $200 OR Shoreland Erosion Control(SE)$400 Base Fee=$ 400 . 00 <br /> DCheck box to apply$200 base fee for Shoreland Erosion Control <br /> (SE)projects meeting criteria in s. 11.05(2)(c) Total Fee=$ 4 5 0 • 5 0 <br /> Notes: <br /> 1.All requirements included in this application correspond to the requirements set forth in Chapters 11 and/or 14 of the Dane <br /> County Code of Ordinances. <br /> 2. By submitting this application, permittee and landowner permit Dane County staff to enter project property for inspection and/or <br /> curative action(s. 11.05(5)(a)3 or 14.49(4)(c)). <br /> 3.Late filing fee: The permit fee shall be double. here work has begun before a permit has been obtained(s. 11.50(7)or <br /> 14.55(2)(b)). <br /> Applicant Signature: Date/ 2C.)/ -If the person submitting the ap• catio i of the rarer,a notarized statement authorizing the applica t to act as the <br /> landowner's agent must be attached. <br /> This application must be submitted in person (M-F, 8 A.M. — 4 P.M.) <br /> with two copies of all permit materials & fees to: <br /> Water Resource Engineering Division, 5201 Fen Oak Drive, Room 208, Madison, WI 53718 <br />